June 05, 2007

This Is Not Pro-Life

by hilzoy

I've always been puzzled by the brouhaha about "partial-birth abortion", at least among people who bother to look past the name the anti-abortion movement has chosen to give to intact D&X. Intact D&X involves sucking a fetus' brains out so that it can be delivered intact. This is pretty gruesome, but less so than the alternative, which is to tear the fetus limb from limb and extract it that way. Since the fetus is anaesthetized (anaesthesia given to the woman passes through the placenta), and since there is considerable doubt about whether second trimester fetuses can feel pain in any case, pain is not an issue, though if it were, intact D&X would seem clearly preferable. It also seem more respectful of the fetus, at least to me.

Most of all, however, I have never seen why this ban matters to those who would like to prevent abortions, since it will not prevent a single abortion from occurring. It will only mean that doctors will use a technique that kills the fetus just as surely as intact D&X, in a more gruesome way, and with a real possibility of producing more complications for the woman.

Marty Lederman notes an article in the Washington Post that suggests that for some anti-abortion activists, the increased risks to women are a feature, not a bug:

"In a highly visible rift in the anti-abortion movement, a coalition of evangelical Protestant and Roman Catholic groups is attacking a longtime ally, Focus on the Family founder James C. Dobson.

Using rhetoric that they have reserved in the past for abortion clinics, some of the coalition's leaders accuse Dobson and other national antiabortion leaders of building an "industry" around relentless fundraising and misleading information. (...)

In an open letter to Dobson that was published as a full-page ad May 23 in the Colorado Springs Gazette, Focus on the Family's hometown newspaper, and May 30 in the Washington Times, the heads of five small but vocal groups called the Carhart decision "wicked," and accused Dobson of misleading Christians by applauding it.

Carhart is even "more wicked than Roe" because it is "not a ban, but a partial-birth abortion manual" that affirms the legality of late-term abortions "as long as you follow its guidelines," the ads said. "Yet, for many years you have misled the Body of Christ about the ban, and now about the ruling itself."

A Focus on the Family spokesman said that Dobson would not comment. But the organization's vice president, Tom Minnery, said that Dobson rejoiced over the ruling "because we, and most pro-lifers, are sophisticated enough to know we're not going to win a total victory all at once. We're going to win piece by piece."

Doctors adopted the late-term procedure "out of convenience," Minnery added. "The old procedure, which is still legal, involves using forceps to pull the baby apart in utero, which means there is greater legal liability and danger of internal bleeding from a perforated uterus. So we firmly believe there will be fewer later-term abortions as a result of this ruling.""

Brian Rohrbough, president of Colorado Right to Life and a signer of the ads, disagreed.

"All you have to do is read the ruling, and you will find that this will never save a single child, because even though the justices say this one technique is mostly banned -- not completely banned -- there are lots of other techniques, and they even encourage abortionists to find less shocking means to kill late-term babies," he said. (...)

In Rohrbough's view, partisan politics is also involved.

"What happened in the abortion world is that groups like National Right to Life, they're really a wing of the Republican Party, and they're not geared to push for personhood for an unborn child -- they're geared to getting Republicans elected," he said. "So we're seeing these ridiculous laws like the Partial-Birth Abortion Ban put forward, and then we're deceived about what they really do." (emphasis added)

So a spokesman for Focus on the Family thinks it's a good thing that the safer procedure for abortions at this stage has been banned. The greater "danger of internal bleeding from a perforated uterus" is a plus, for him. Apparently, healthy mothers aren't an important part of the families his group focusses on.

I always thought that the anti-abortion movement's newfound focus on abortion's alleged harms to women was a pretty transparent gimmick. The harms might charitably be described as unproven, and that the idea that women need to be protected from choices they would regret is condescending, especially when it's not accompanied by calls to ban other decisions people might regret, like the decision to take out a mortgage, or join the marines, or get married, or, for that matter, to have a child. (If anyone were to propose banning all choices that people might regret, I assume they would be laughed off the public stage. Why this doesn't happen to people who confine this line of argument to women's reproductive choices is an exercise left to the reader.)

At least Focus on the Family has made their disregard for women's health explicit.

Comments

I always thought that the anti-abortion movement's newfound focus on abortion's alleged harms to women was a pretty transparent gimmick.

From what I've read, I think Feminists for Life and similar groups are actually historically correct to trace this argument back to Susan B. Anthony and other feminists of her day.

As I understand it, the point is that in a society where women had virtually no rights to speak of, abortion was purely a matter for a man's convenience, a way to avoid the consequences of knocking someone up. So the goal of enforcing laws against abortion was to prevent women from being used in this manner.

Today, of course, society is far different. While women may still be pressured to have abortions in some circumstances, the law recognizes their autonomy and gives them the final say. The arguments that actually made some sense over a century ago simply don't apply any more.

I suspect we may have a lumping problem here. Focus on the Family isn't all pro-lifers, in fact the article itself shows a divide between them. And like pro-choice groups (I'm thinking specifically of NOW and NARAL) the positions adopted by the leaders appear to be more extremist than many of the followers. The Jesurgislac/NARAL 'abortion until it comes out of the womb no matter how viable' is not anything like the majority pro-choice opinion, much less the majority opinion of the electorate as a whole. Similarly the FOF position doesn't represent the pro-life position so much as it represents the extreme pro-life professional advocate position.

Hilzoy, I've always figured that you can tell the claim pro-life groups make to be "anti-abortion" is a lie, because not one pro-life group advocates free provision of contraception to all and mandatory education in how to use contraception - not one. And many actually oppose free access to contraception, thus ensuring there will be more abortions. Further, while the leaders of the pro-life movement (mostly male) may sincerely believe that they want to go back to the days when women suffered through unwanted pregnancies or died in illegal abortions, but I think the evidence is long since in that no woman wants that for herself, whatever placard-waving opposition she presents to other women getting the abortions they need.

Sebastian: The Jesurgislac/NARAL 'abortion until it comes out of the womb no matter how viable' is not anything like the majority pro-choice opinion, much less the majority opinion of the electorate as a whole.

What exactly does this have to do with the topic of the article: the preference of some pro-lifers (such as yourself) and some pro-life groups, for seeing the denial of a safer method of abortion as a matter for celebration?

As Hilzoy points out: banning a safer method of abortion, forcing doctors to opt for a more dangerous method, does not prevent abortions: it merely makes more likely damage to a woman's health and future fertility. You spontaneously celebrated the legal denial of safer abortions, the increased likelihood of wrecked cervixes, as a victory for the pro-life movement earlier on Obsidian Wings: are you saying you agree with Dr Dobson that making women suffer is really what being pro-life is all about?

I just read the posting rules reminder post. In defense against the Wrath of Hilzoy, should it be evoked, I probably wouldn't have directed a comment specifically against Sebastian if he hadn't directed a comment spontaneously against me.

I'm pretty sure there are other alternatives to intact D&X. In fact, that we're even alive and discussing this pretty much proves there are other alternatives, since you can't have much of a discussion if your brain was sucked out while in the birth canal.

"Most of all, however, I have never seen why this ban matters to those who would like to prevent abortions, since it will not prevent a single abortion from occurring."

Clearly, because they view this as the thin edge of the wedge. Now that they've established that an abortion procedure CAN be banned, they'll start driving the wedge in, exploring the limits of what the Court will permit to be banned, and what logic the Court uses in drawing those lines.

There are alternative methods of performing a late-term abortion. Quite often the doctor performing the abortion may not be able to judge which will be the safest method until the woman is anesthetized

At that point, the pro-lifers in the audience - at best - want the doctor to risk prosecution by going ahead and doing their best for the patient. Or, if they're on Dr Dobson's side (as Sebastian, rather ironically, evidently is) they want the doctor to use a method less safe for the patient, because they like the idea of more women suffering perforating uteruses or damaged cervixes.

In fact, that we're even alive and discussing this pretty much proves there are other alternatives, since you can't have much of a discussion if your brain was sucked out while in the birth canal.

The "alternative" to IDX isn't a live baby, Brett. The alternative to safe legal abortion is to let women die or risk permanent sterility. Which is your preference - safe medical procedure versus damaged women?

Or, if they're on Dr Dobson's side (as Sebastian, rather ironically, evidently is)

I thought Sebastian merely stated that the expressed viewpoints are - on both sides -more extreme than those of the majority of the supporters of the movement.

I agree that the ban is stupid because it will let people fall back on more horrific methods. Seeing that, and the increased risc to maternal health as an *advantage* shows that you do not care much about human life in general.

My own idea about fetal pain is that it is pretty likely to be felt at the stage a D&X/partial birth will be performed. No one seems to know for sure and at that phase of the pregnancy I always felt responses to all sorts of stimuli (hand on belly, sharp light, loud music).

Wether the baby gets sedated through the placenta is very debatable too. But when a practised doctor performs the procedure the killing stab might well be less painfull/stressfull than trying to sedate. If you decide there must be an abortion (which for me depends on the viability of the fetus) you might as well choose the least bad method.

one interesting aspect of Congress's ban (much discussed at Lawyers, Guns and Money [a very good blog which should appear over there <== somewhere]) is that it puts the lie to those who claim to support returning abortion regulation to the states. Where were these people when Congress acted?

it seems that we are all faint-hearted federalists.

it is also worth noting that there are any number of valid medical reasons for a third-trimester abortion. fetal death, for one.

since the treatment of the fetus appears to be a legitimate concern, it seems likely that the next time there's a republican congress and president all forms of abortion other than by caesarean will be banned.

if we ever had a woman president and a majority-female congress, i wonder what laws they would pass with respect to men's sex lives. mandatory lessons in cunnilingus? truth in length laws? debtor's prison for deadbeat dads?

What I have not seen mentioned (except by me ::sigh::) is that one consequence of banning intact D&X is often the death of *more* children.

Why? Because intact D&X is often the best way to get out a dead or dying twin without endangering its healthy sibling. Even those of you who don't know nothin' 'bout birthin' no babies can easily see that not having to open the cervix as wide to get out the dead twin is *much* more likely to let the healthy one stay in the warm for another couple of months.

I myself know a very nice, healthy little person who probably wouldn't have been born, and certainly wouldn't have been born so healthy, if the doctors hadn't been able to use intact D&X to get out his sibling.

Dutchmarbel: My own idea about fetal pain is that it is pretty likely to be felt at the stage a D&X/partial birth will be performed. No one seems to know for sure and at that phase of the pregnancy I always felt responses to all sorts of stimuli (hand on belly, sharp light, loud music).

I'm fairly certain most D&X abortions are performed during the second trimester, well before there's any possibility of the fetus experiencing pain. In fact, it's very unlikely a fetus could be capable of feeling pain until at least the seventh month.

Dr. Science, keep in mind that the federal PBA ban -- horrible as it is -- doesn't ban performing a D&X if the fetus is already dead. So there's no legal barrier to a doctor using D&X to remove a dead twin from a woman's body.

That said, a ban is still potentially harmful in the situation you describe, in which one twin has died and needs to be removed. First of all, if the ban remains in place than fewer doctors will have the training and experience to perform a D&X.

Secondly, doctors may not understand that the PBA ban does not apply to a situation like the one you describe, and so may refuse to perform a D&X because they mistakenly think it's illegal. Or they might understand that it's technically legal, but not be willing to risk the wrath of a local pro-life DA interpreting the law overly broadly. In either case, Doctors are motivated to use less safe procedures.

This article has some interesting/appalling information about the new, often unproven techniques doctors are considering as alternatives to D&X. Some of these techniques have been nicknamed "Kennedy abortions," in "honor" of Justice Kennedy.

Brett: Right, because abortion is the only medical procedure for which demand is utterly, one hundred point zero repeating percent inelastic.

If you're pregnant, Brett - which of course you never will be, but if you care to think about it a moment - you have exactly two choices: to abort, or to stay pregnant and try to have a baby. There are no other choices: it's one of those two-valued decisions.

It's absolutely possible to create a society where there's less demand for abortions, but this is done by methods to which pro-life organizations are unalterably opposed: mandatory education in contraceptive use, societal encouragement to use contraceptives if there's no intent to conceive, and free access to and availability of contraceptives for all. Or, where a woman is pregnant and knows she can't support another child, there are methods of creating a society where she can choose to have that child, but those are methods to which right-wingers are unalterably opposed: free health care for all, mandatory paid maternity leave, financial support for single/low-income mothers.

Demand for abortion isn't inelastic. But once a woman is pregnant, if she doesn't want to have the baby, or if something goes wrong so that she can't have the baby, demand for abortion is absolutely inelastic: one unwanted/unsafe pregnancy, one abortion.

"Well, duh. If the woman needs to have an abortion, it's never, ever a baby being born alive."

Well since you have cases in the UK of children who have survived abortions I can't say I agree.

I wish I could see the exact quote that caused the BBC reporter to write: "Pro-choice groups say that while hers is a distressing story it is unusual and that guidelines are in place in the UK to stop live births after abortions."

I hope that they weren't suggesting that it is distressing that she lived. "...guidelines are in place in the UK to stop live births after abortions".

Well since you have cases in the UK of children who have survived abortions I can't say I agree.

One case from 30 years ago from the US, to be precise. The article you linked to references Gianna as "American-born", and offers no evidence but Gianna's personal testimony to events that, self-evidently, she cannot actually remember.

Incidentally, the woman claims that the abortion took place in the US in 1977 at 33 weeks by saline injection - a method no longer much in use, as it's considered unsafe. When it use, it is most commonly used between 16 and 24 weeks. The whole story reads like a pro-life moral fable, not a true tale: I wonder if Snopes has researched it?

I wish I could see the exact quote that caused the BBC reporter to write: "Pro-choice groups say that while hers is a distressing story it is unusual and that guidelines are in place in the UK to stop live births after abortions."

It's:

Ann Furedi, chief executive of the British Pregnancy Advisory Service, said it was important to remember that late abortions, like that of Gianna's mother, are uncommon.

"These stories are extremely distressing. But the point we would always make is that these very late abortion at times when there is a potential for life are very few and far between.

"And there is very clear guidance to make sure this sort of thing does not happen."

She added that cases like Gianna's were now less likely to happen because of advancing technology and tightened regulations, and that when a woman opted for a late abortion it was usually because the babies had a foetal abnormality.

"If women have a wanted pregnancy and go into labour prematurely they need to know that everything will be done to their babies, but if they need to have an abortion at this late stage then the intention will be that there is not live birth and the procedure should avoid a live birth."

It turns out to not be difficult to find the quote, since it's in the story.

I wouldn't have summarized that quote in the way that the BBC reporter did, but ok.

Responding to that quote, I would think that it isn't clear what she thinks is distressing though I suspect a fuller quotation would help explain it. The part that I find disturbing is:

She added that cases like Gianna's were now less likely to happen because of advancing technology and tightened regulations, and that when a woman opted for a late abortion it was usually because the babies had a foetal abnormality.

"If women have a wanted pregnancy and go into labour prematurely they need to know that everything will be done to their babies, but if they need to have an abortion at this late stage then the intention will be that there is not live birth and the procedure should avoid a live birth."

I'm not at all sure it is obvious that if there could be a live birth and the child could survive if not actively killed, that we should allow the doctor to kill the child. Maybe it is just sloppy phrasing, but she seems to be saying "In some cases if the mother wanted a live birth, we would do whatever we could, but if she wants a dead one, we should do whatever we can to make darn sure that fetus doesn't make it". She isn't expressing concern for the mother's health there, she is expressing concern that horror of horrors the fetus might be delivered live.

I don't anticipate getting much into the substance of an abortion debate, but I would note that -- unless I'm misinformed -- cases such as that of Ms. Jessen's seem to be about as rare as the Elephant Man, and thus not of much use as an illustration of anything more common.

"But once a woman is pregnant, if she doesn't want to have the baby, or if something goes wrong so that she can't have the baby, demand for abortion is absolutely inelastic: one unwanted/unsafe pregnancy, one abortion."

Because, you see, nobody EVER changes their mind about having an abortion.

Is it possible to defend your position without making these absurd claims? I must think it is, so why do you make them?

Ampersand: I'd read that D&X is mainly used after 20 weeks gestation. Your article quotes statistics and probabilities; I've trouble enough convincing my doctors that those does not provide absolute truths about an individual.

However, since I also said that I thought the partial birth procedure was in all likelyhood less stressfull and painfull than many other options. I think I'd rather have that option than injecting with dioxin (or saline).

Under what conditions abortion should be possible is a different discussion than the one about what method is best once the choice for abortion is made.

For me it's a bit like the discussion a few days ago about execution methods. Guillotine might wel be much better than injections, hangin and electric chair, but has a much more barbaric image. Being against capital punishment does not mean you cannot express an opinion about the methods used. If they banned the deadly injections because they proved that it is actually quite painfull (I thought that was a theory a while ago), and people who are against capital punishment would enjoy the fact that there will be much more botched executions because they will have to fall back on the electric chair, you might feel doubt about their sincerity.

" don't anticipate getting much into the substance of an abortion debate, but I would note that -- unless I'm misinformed -- cases such as that of Ms. Jessen's seem to be about as rare as the Elephant Man, and thus not of much use as an illustration of anything more common."

The UK report suggested 30 a year. And are they less common only because they couldn't survive, or because if "the intention will be that there is not live birth and the procedure should avoid a live birth."

So how come they couldn't find a British person, and had to import an American?

Anyway, if there are 30 a year -- is that in the UK, or the world? -- year after year, than even if it's only 30 a year in the entire world for the past 20 years alone, that makes for 600, so presumably you can point to... five more?

Note that 30 a year in the whole world would be out of 6.6 billion people. 1 in 220, 000,000. This is not typically considered a frequent occurence.

The UK population is approximately 60 million plus. So 30 a year would be 2 in 1,000,000. This also does not tend to be considered to be very common.

Of course, since they haven't used the saline technique in decades, we're told, the numbers would presumably have to be far less.

Another survivor (from two years ago) is mentioned in the linked story though it isn't clear if the mother carried the baby for an additional time after the three failed abortion attempts or if he was born just after the third.

I'm not actually an abortion survivor, but I can empathically suspect that many of them might not be-super thrilled about going in front of lots of people and talking about it. You have the clear emotional baggage of having you mother try to (at least from your current perspective) kill you and probable side-effects from the abortion procedure.

"Whilst there may be rare cases where some infants survive following legal abortion, CEMACH is not yet in a position to confirm the extent of this. CEMACH will be carrying out future work to try to establish how many babies this affects; it must be noted that babies surviving past 28 days of life will not be included in our reported figures. The work on infants surviving abortion will form part of a much wider report into perinatal mortality, due to be published at a later date."

It's also the case that it may be very difficult to be absolutely certain that the one twin is completely dead, not just mostly dead. In the case of my young friend I don't know (because it isn't my business) if the abortion was performed post-mortem or pre-. I do know, though, that it was a *very* serious, very time-sensitive decision, and that delaying it could easily have doomed him along with his sibling.

But I'll Sebastian and Brett one thing. I'll bet that "trying to save one of a pair of twins" happens a hell of a lot more often than "fetus survives abortion."

I'd never heard of this study, and The Times is the print version of Fox News for the UK (quite literally: it's owned by the same man), so I'd be careful about considering it a reliable source where it's clearly playing to its base. (Incidentally, Stuart Campbell, who claims 19-week fetuses are "born breathing and crying", is a pro-life campaigner running a "health clinic" in London which appears to consist primarily of an opportunity for prospective mothers to get 3D scans of their fetuses, and is talking out of his ass: a 19-week fetus doesn't have the lung development.)

Like multitudes before me and, I trust, multitudes to come, I eventually heard (Try as I might to avoid hearing it!) in that mother's grief-filled declaration, "Oh God, Doctor, I was hoping it was cancer", a still, small voice asking, "Whom shall I send, and who will go for us?" to which I was at last compelled to reply, "here am I, send me."

I dare say that any woman who genuinely thinks it's better to have cancer than to merely be pregnant, (As opposed to some kind of pregnancy related medical problem such as ectopic pregnancy.) either has not the slightest conception of cancer, or is off her rocker.

Brett: I dare say that any woman who genuinely thinks it's better to have cancer than to merely be pregnant, (As opposed to some kind of pregnancy related medical problem such as ectopic pregnancy.) either has not the slightest conception of cancer, or is off her rocker.

Or else - and you might just want to think about this a little bit - actually knows how much she and her other children are going to suffer because of one more child she can't afford to support, and having cancer would actually have been an improvement.